October 17, 2011

How Pakistan's Crises Are Undermining Public Health

A recent dispatch in the Los Angeles Times contains more bad news from Pakistan—but not the kind Americans have come to expect. This latest news is about polio eradication efforts in that country, which, according to the article, are “faltering” in a climate of widespread anti-American sentiment and religious fundamentalism that is suspicious, even hostile, toward vaccinations (a sentiment only strengthened when news emerged that the U.S. had organized a fake vaccination drive in an effort to get a DNA sample from the family of Osama bin Laden). Some public health officials in the region have even been assassinated by the Taliban. But how do scholars assess the progress of polio eradication?

A variety of studies and reviews confirm that observers are increasingly worried. A 2010 article in the Bulletin of the World Health Organization notes that while the “initial success” of eradication efforts in Pakistan was “remarkable,” “since 2007, there has been a marked resurgence of polio cases.” Indeed, as a 2011 article in Nature notes, out of the four countries where the disease remains endemic, Pakistan is the only one “in which polio is making a comeback.” This is due in part to the impact of war on that region, but efforts have also been hampered by corruption, poor sanitation, and insufficiently-funded and unreliable public resources. Reports occasionally contain small reasons for hope: For one, religious opposition to the vaccine has not proven universally insurmountable. A 2009 article in the WHO’s Bulletin described outreach efforts to religious leaders and noted that as recently as 2007, engagement with those leaders had softened opposition (and increased vaccination numbers) in Pakistan’s Northwest Frontier Province. This, as officials know, is critical to the success of broader eradication efforts: As the British medical journal The Lancet noted earlier this year, Pakistan “accounts for 60% of polio cases among endemic countries, and is the only country with an increase in cases from 2009,” making it “the final frontier for a polio-free world.”